Micah Arsham, MSTOM, LAc
The Zhen Qi Tang (真气堂) clinic is a busy, privately run clinic in Lanzhou, the capital of Gansu Province in northwestern China. Lanzhou is an ethnically diverse city, and the powerful, muddy Yellow River runs through its center. Because of its location at the southern part of the Silk Road (Gansu Corridor), Lanzhou has always been a center of trade and cultural exchange. Not far from Lanzhou are the Mogao Caves at Dunhuang, which hold a rich and vast collection of Buddhist art; in 1990, a library cave was also discovered, containing many ancient relics and texts. Mosques can be found both in the capital and in the surrounding areas, where farmers grow wheat, potatoes, and lily bulbs, among other crops.
The owner of Zhen Qi Tang, Dr. Tan Sheng (谈升), sees over 60 patients a day, and over 150-200 patients receive care each day in the clinic. The clinic provides comprehensive treatment with classical Chinese medicine. Unlike many hospitals throughout China that provide Traditional Chinese Medicine (TCM) services, the Zhen Qi Tang clinic, which has about 25 full-time employees, does not provide any Western medical services. The clinic offers a variety of traditional modalities, and patients may bring their medical records (X-ray from a hospital, lab work, etc.) if they like, but the approach at Zhen Qi Tang is based exclusively on classical Chinese medicine.
Dr. Tan was born in Lanzhou and practices a lineage-based, Daoist style of medicine. Since age 18, he studied martial arts with Dr. Prof. Li Shaobo (李少波), who died in 2011 at age 103. Dr. Tan studied classical Chinese medicine with Dr. Huang Xiping (黄西平) and Dr. Liu Yunteng (刘云滕). Although Dr. Tan’s son, Tan Jiming (谈济铭), studies TCM at the local university, he also works in his father’s clinic to learn the classical style of Chinese medicine Dr. Tan espouses. The Yellow Emperor’s Inner Canon (Huángdì nèijīng黄帝内经) and the Classic of Difficult Issues (Nànjīng 难经) are the foundation of daily practice in the clinic; similarly, the formulas used at Zhen Qi Tang are all based on classical sources, specifically Zhang Zhongjing’s On Cold Damage (Shānghán lùn伤寒论) and Prescriptions from the Golden Coffer (Jīnguì yàolüè fānglùn 金匮要略方论).
In August of 2012, Pacific College of Oriental Medicine faculty member Dr. Ji Dong (冀栋) brought four students to learn from Dr. Tan in Lanzhou. After completing his degree in TCM in Beijing, Dr. Ji continued his studies as an official disciple (by both private ceremony and state issue) of Dr. Tan, before moving to the United States. Dr. Ji specializes in the classical approach taught to him by Dr. Tan, and wanted to share the authenticity of this lineage-based approach with a few of his students from PCOM in San Diego. During the month at Zhen Qi Tang, Dr. Tan organized special seminars for the PCOM group and clinic staff, to supplement the days spent in the clinic to observe, practice, and learn classical Chinese medicine. These classes were on the topics of history, philosophy, clinical techniques, and qi cultivation. Teachers included professors from Gansu Academy of Social Sciences, such as Professor Xie Zenghu (谢增虎), and from Lanzhou University, such as Professor Liu Yongmin (刘永民). Professor Liu gave a lecture on Daoism and Chinese medicine in which he talked about a text influenced by Daoism, the Canon of Decoction Methods (Tāngyè jīngfǎ 汤液经法), a version of which was found at Dunhuang; he compared formulas from this work to those from Zhang Zhongjing’s On Cold Damage.
The classical style informs every aspect of Zhen Qi Tang; however, Dr. Tan constantly improves the tools and techniques used in his clinic. In cases of edema in the legs, a procedure Dr. Tan designed is to iron over a patient’s legs through a protective cloth that is soaked in an herbal decoction…the iron in the clinic is not for the uniforms! ‘Stone therapy’ (石疗) is when a bag of small stones is heated in the microwave, and then applied to a patient’s body with a specific motion, similar to that of tuina (推拿). Many of these devices (such as contraptions for moxabustion that attach to the umbilicus and are held with an elastic band) are his inventions. He teaches the procedures for all of them, including protocols for more standard techniques like cupping (拔罐) and guasha (刮痧), to his employees. The clinic team has regular meetings and proficiency tests to review their training and development as practitioners of classical medicine. They work long hours together, may have the option to live in housing near the clinic, and can practice qi cultivation (specifically, 八段锦) under the instruction of Dr. Tan. He is their teacher, not just employer.
Patients come by the clinic early each morning, check-in, and get an appointment for a time slot later in the day. Often there is a long line of patients in the morning; in the afternoon vendors sell vegetables and fruits on the street outside. The neighborhood is primarily residential, with some businesses, including places to find the traditional beef noodle soup, for which the city is known. The soup contains many Chinese herbs, including huā jiāo, but the exact recipe is a secret kept by the families (primarily Hui ethnic minority) who sell the soup. The clinic has a superior reputation, and Dr. Tan treats patients from many backgrounds, including: llamas from the nearby Labrang monastery, government officials, and patients of all ages.
Dr. Tan sees patients with many types of illnesses, including: arthritis, pain, cough, miscellaneous dermatological conditions, menstrual problems, heart disease, high blood pressure, stress, and insomnia, to name only a few. In the clinic there are separate rooms for moxabustion therapy, pediatric treatment, tuina, women’s acupuncture, men’s acupuncture, as well as Dr. Tan’s office, where patients are first evaluated. After seeing Dr. Tan on the upper level, where the large windows of his office let in ample light and the noise of street traffic blends with pleasant recorded music, patients take their prescriptions to a counter downstairs that dispenses packets of bulk herbs. On the lower level there is also a room where patients can have the formulas cooked for them. If they are returning for follow-up care and do not need an herbal consult, they go directly to the treatment rooms, which have a communal, social environment.
Although quiet during the lunchtime rest period and in the late afternoon, both mornings and afternoons are extremely fast-paced. Dr. Tan’s office, the heart of the clinic, is usually filled with a sea of patients and their families. Sometimes the crowd spills into the hallway of the upper level where there are a few benches. On the wall behind his desk are photos of the doctors of his lineage: Li Shaobo, Huang Xiping, and Liu Yunteng. A pulse pillow with the clinic’s name written on it sits on the desk, and stacks of prescriptions from that day sit under paperweights. Behind the desk is an impressive piece of calligraphy by an eccentric intellectual, artist, author, and friend of the Dali Lama, Mr. Zheng Tielin (郑铁林). Presently quite advanced in age, though young in spirit, Mr. Zheng was imprisoned for thirty-six years, including during the Cultural Revolution. In conversations with Dr. Tan, Mr. Zheng articulates that, in his opinion, the classical approach to Chinese medicine is most effective. He likes that “every human part” is used in classic formulas, such as urine from a six year-old boy, the crotch of “old pants” (i.e. with menstrual blood), hair, and nails. Despite being offered exorbitant sums of money for Mr. Zheng’s calligraphy, Dr. Tan would never part with it.
Despite seeing so many patients, Dr. Tan often takes the time to elaborate to his students about the treatment principle and prescription choice, and how it relates to traditional principles. For instance, he would ask, “why use evodia [fruit] (wú zhū yú)to warm up the spleen yang?” The answer would be, “to use the reverting yin to warm it up.” Similarly, Dr. Tan would often use the light nature of lotus leaf (hé yè) to lift the qi in cases of persistent diarrhea, as in the following case, in which a modified Mume Pill (wū méi wán) is used:Dr. Tan’s office has one desk where he sees patients, as well as another desk where his assistants (two employees, often his son, or Dr. Chen Xiaodong [陈晓东], or Dr. Bao Fangfang [包芳芳], assist in the intake process). Dr. Tan goes between the three stations, where he feels pulses, reviews the inquiry examination notes, and dictates herbal prescriptions. Occasionally, Dr. Tan leaves the room for a few moments to give an acupuncture treatment. He is trusted and respected by his patients, and often multiple generations in families see Dr. Tan for their regular medical care. When working, Dr. Tan moves in a way that shows his energy is summoned and focused at every moment; he is very attentive to his patients and to everything going on in the room.
August 21st, 2012
Male, age 41
The patient has discomfort in the epigastrium, loud intestinal sounds, decreased appetite, and left rib-side pain. He has an aversion to cold and catches colds easily. There is fatigue and lack of energy, he sweats easily, and wakes easily during sleep. After eating oily food the patient has a tendency to have loose stools, and he is easily angered. The pulse is wiry-moderate (弦缓), the left guān position has tension and is not soft (左关不柔). The tongue is pale, and the tongue coating is thick in the middle and slightly yellow. The patient’s lips are red, and his cheeks are also slightly red.
Prescription: mume fruit (wū méi) (18g), dried ginger (gān jiāng) (10g), coptis (huáng lián) (5g), scutellaria (huáng qín) (4g), zanthoxylum (chuān jiāo) (1.5g), cinnamon twig (guì zhī) (15g), asarum (liáo xì xīn) (8g), white ginseng (bái rén shēn) (8g), blast-fried aconite (pào fù piàn) (10g), stir-fried lablab (chǎo biǎn dòu) (15g), poria (fú ling) (15g), lotus leaf (hé yè) (8g), prepared licorice (zhì gān cǎo) (8g).
Prescription: Five packets of herbs; three acupuncture visits; two applications of herbal paste to the umbilicus.
Dr. Tan routinely uses Zhang Zhongjing’s formulas, but with characteristic modifications from his years of experience and in accordance with a patient’s progress. Frequently used base formulas include: Channel-Warming (Menses-Warming) Decoction (wēn jīng tāng), Minor Green-Blue Dragon Decoction (xiǎo qīng lóng tāng), Coptis Decoction (huáng lián tāng), Aconite Center-Rectifying Decoction (fù zǐ lǐ zhōng tāng), Center-Rectifying Decoction (lǐ zhōng tāng), Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction (guì zhī lóng gǔ mǔ lì tāng), and others.
Each day one or two cancer cases are seen in the clinic, and over the years Dr. Tan has treated many types of cancer with traditional methods. In a single day at Zhen Qi Tang, a patient with laryngeal cancer was seen, and one with advanced breast cancer. Over the past two years, about 90 cancer patients have gotten regular treatments at Zhen Qi Tang. Dr. Tan has experience with lung cancer, liver cancer, cervical cancer, rectal cancer, kidney tumors, leukemia, stomach cancer, breast cancer, pancreatic cancer, throat cancer, bone cancer, and large intestine cancer. One patient, a woman age 50, had liver cancer and cirrhosis from Hepatitis B, which she contracted at a young age. She presented with an enlarged abdomen, dark facial color, and emaciation. Other hospitals wouldn’t accept her for treatment, but Dr. Tan gave her an herbal prescription to treat the ascites. After two doses of herbs, the abdominal fluid volume decreased by two thirds. Another patient, a 70 year-old woman, presented with lung cancer that had metastasized to the bone. She was in severe pain, which was not well controlled. Her pain lessened with treatments at Zhen Qi Tang and she continued to see Dr. Tan for ten years, until dying in 2012 at age 80 of heart failure. In these cases, Dr. Chen emphasizes that the focus of traditional Chinese medicine is on the person, not on the disease.
Dr. Chen explains that patients who get chemotherapy treatment tend to suffer more, but treatment with Chinese medicine helps them to be more comfortable. Breast cancer patients are often treated with moxabustion and breast massage, and they get better results in patients who have not undergone surgery, as scar tissue impedes the circulation locally. Moxabustion treatment usually consists of the points: CV-4, CV-3, CV-7, CV-12, zǐ gōng, and ST-29. The extra point zǐ gōng is supplemented, as the “breast is related to the uterus.” He notes that according to the Yellow Emperor’s Inner Canon, if the uterus has enough blood, the blood can go to the breast to make milk. Accordingly, nurturing post-natal essence from the spleen and stomach is important to a patient’s recovery, as she must have the material substance to support the recovery procedures. Dr. Chen has observed that the majority of breast cancer patients seen at Zhen Qi Tang can survive and maintain their health for many years.
In another case, a 58 year-old male presented with lung cancer. He had undergone surgery and was suffering from oppression in the chest (胸闷). He wasn’t able to sleep well. His face was dark and his build was slim. The diagnosis was blood stasis and cold-dampness in the chest; Dr. Bao explained, that in this case, the root was vacuous and the branch was replete. The treatment principle was to warm the lung and transform rheum (溫肺化飲), promote qi absorption and calm panting (纳气平喘).
The prescription, Minor Green-Blue Dragon Decoction (xiǎo qīng lóng tāng), was modified as follows: raw ephedra (shēng má huáng) (10g), cinnamon twig (guì zhī) (15g), white peony root (bái sháo) (15g), dried ginger (gān jiāng) (18g), asarum (xì xīn) (12g), raw pinellia rhizome (shēng bàn xià) (15g), prepared schisandra [berry](zhì wǔ wèi) (15g), crude dragon bone (shēng lóng gǔ) (20g), raw oyster shell (shēng mǔ lì) (20g), red ginseng (hóng shēn) (9g), ginko nut (bái guǒ) (8g), coltsfoot (kuǎn dōng huā) (10g), aster (zǐ wǎn) (10g), cornus fruit (shān zhū yú) (30g), and prepared licorice (zhì gān cǎo) (8g); four packets were prescribed. When the patient returned, all the symptoms were less pronounced, and five packets of the same formula was prescribed, with ginko nut (bái guǒ) removed and blast-fried sliced aconite [accessory root] (páo fù piàn) (20g) added. On the third visit when five more packets were given, coltsfoot (kuǎn dōng huā) and aster (zǐ wǎn) were removed, and ginko nut (bái guǒ) was added. On the fourth visit, the cough was less pronounced and the patient could lie down, although he was tired. Six packets of Minor Green-Blue Dragon Decoction (xiǎo qīng lóng tāng) were given, with the additions of crude dragon bone (shēng lóng gǔ) (20g), raw oyster shell (shēng mǔ lì) (20g), white sliced aconite [accessory root] (bái fù piàn) (20g), ginko nut (bái guǒ) (8g), and earthworm(dì long) (8g).
On the fifth visit, he had chemotherapy and was tired, could not eat, and had insomnia. Five packets of a modified Aconite Center-Rectifying Decoction (fù zǐ lǐ zhōng tāng) were prescribed: blast-fried sliced aconite [accessory root] (páo fù piàn) (24g), dried ginger (gān jiāng) (8g), white atractylodes [root] (bái zhú) (15g), red ginseng (hóng shēn) (10g), prepared licorice (zhì gān cǎo) (15g), amomum [fruit] (shā rén) (6g), stir-fried crataegus (chǎo shān zhā) (15g), stir-fried barley sprout (chǎo mài yá) (20g), cinnamon twig (guì zhī) (15g), cuscuta seed (tù sī zǐ) (15g), psoralea [fruit] (bǔ gǔ zhī) (15g), and cornus fruit (shān zhū yú) (30g). By the next visit, the patient had stopped chemotherapy treatment and he could eat. Dr. Bao went on to explain five subsequent modifications, after which the patient was well enough to take Aconite Center-Rectifying Pills (fù zǐ lǐ zhōng wān).
At Zhen Qi Tang the classical approach to Chinese medicine is fairly pure. Dr. Tan stays close to the traditions and ancient texts; he continues to study the classics and relate them to his clinical practice. Each patient is viewed within the framework provided by the canonical texts of Chinese medicine. However, it is not only knowledge of classic texts, but also Dr. Tan’s prioritization of balance, movement, and natural rhythms that define the clinic. He models the tenet that through cultivating one’s qi, one’s pulse taking and acupuncture skills can improve. The clinic is an ever-developing place, where Dr. Tan both provides medical care and trains other practitioners in his style, which has been refined by experience over time. This article touched on only a few cases to show Dr. Tan’s approach to prescription writing, which is a daily, vital activity that serves the people of Lanzhou.
Micah Arsham is a licensed acupuncturist and herbalist in San Diego. She holds a MS from Pacific College of Oriental Medicine, where she is a Teaching Assistant, and a BA from Columbia University, where she graduated cum laude.
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